Stemcelldoc's Weblog

October 1, 2013

Rear End MVA: Head Position and Neck Injury

Rear end MVA

At the Centeno-Schultz Clinic we acknowledge the potential impact of motor vehicle accidents on a patient’s well-being.

Injuries to ligaments, facet joints, muscles, intervertebraldisc and nerves can occur.acceleration deceleration

Rear end motor vehicle accidents can cause an acceleration deceleration injury to the cervical spine.

Does head position at time of impact in a rear end MVA matter?  Does it led to injury of specific areas?

Panjabi examined these concerns in a 2006 study.  He concluded that head-turned rear impact caused significantly greater injury at C0-C1 and C5-C6 facet joint, as compared to head-forward rear and frontal impacts which resulted in multiplanar injuries at C5-C6 and C7-T1.

This is significant as the pain referral patterns are different as previously discussed.

The C0-C1 facet refers to the suboccipital area whereas the C5/6 and C7/1 facets refer to the periscapular area.

c0-c1-joint-referral-pain

Periscapular referral pattern of C5/6 and C6/7 facet joint.

Periscapular referral pattern of C5/6 and C6/7 facet joint.

Knowing the importance of head position in a rear end MVA is critical to understanding what areas are at greatest risk for injury and how best to treat them.  This is standard of care at the Centeno-Schultz Clinic.

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August 16, 2013

Epidural Platelet Injections: A safe alternative to steroids

At the Centeno-Schultz Clinic safety is paramount.

Platelet therapies are a safe and effective alternative to steroid epidural injections.

Platelet lysate (PL) and concentrated stem cell plasma (cSCP) are the two platelet treatments.

The efficacy of PL epidural injections compared to tradition steroid injections have been previously discussed.

We are concerned about the contamination of compounded steroid products and its sequelae.

Earlier this year the New England Compounding Pharmacy recalled compounded steroids due to fungal contamination. .   As of March 10, 2013, 48 people had died and 720 were being treated for persistent fungal infections.

 

NASS spine safety alert

This week another safety alert was issued by North American Spine Society and the FDA over concerns of bacterial infections.

Bacterial and fungal infection are serious issues with potentially serious and longterm complications.

If you suffer from ongoing neck or lower back pain consider platelet epidural injections at the Centeno-Schultz Clinic as a safe alternative to steroids.

August 13, 2013

Cervial Epidural Injections: Insist Upon X-ray guidance

At the Centeno-Schultz Clinic patient safety is paramount.

Cervical epidural injections are utilized to diagnose and treat neck and arm pain arising from the cervical spine.

Not all cervical epidural injections are performed in the similar fashion.

Some use x-ray guidance (fluoroscopy with injection of contrast) and others perform the injection without x-ray (blind).

Is there a difference?

Yes

c-arm_fluoroscopy

X-ray is used to guide and confirm the accurate placement of the needle into the epidural space.

Complications associated with not using x-ray:

Spinal nerve injury

Spinal hematoma

Injection into the spinal fluid with onset of hypotension and respiratory arrest.

Spinal cord injury.

Postdural headaches.

Vasovagal reaction.

X-ray also enables the injection of contrast (dye) to demonstrate the location and flow of medication injected.  If flow is limited to the right and the patient has pain only on the left the injection most likely will fail.  X-ray guidance documents the flow of contrast to maximize clinical results.  All cervical injections at the Centeno-Schultz Clinic utilize x-ray guidance.

Cervical-Interlaminar-Epidural-Steroid-Injection-post-contrast

Cervical epiduralw are useful in the treatment of neck and arm pain but require the use of intermittent x-ray (fluoroscopy) to minimize the significant potential complications and maximize clinical outcome.  This is the standard of care at the Centeno-Schultz Clinic.

January 1, 2013

Shoulder injuries and Yoga: Things to know

up dog ygoaDuring my New Year’s day practice I noted the absence of a favorite instructor.  She had suffered a shoulder injury last week. 

Injuries to the rotator cuff, labrum and shoulder ligaments can occur in yoga.  Upward-facing dog and downward dog are particularly stressful on the shoulder and can lead to inury.

I was surprised to learn that she had received a cortisone injection especially given the risks associated with steroids.

In 2013 the Centeno-Schultz Clinic provides some health guidelines for patients.

1) Know the source of your pain.  It is not enough to simply look at the MRI or x-ray.

2) Use diagnostic studies and physical examination to identity injuries.  Studies include but are not limited to x-ray, MSK ultrasound, MRI and CT.

3) All injections need to be performed with guidance.  At the Centeno-Schultz Clinic all injections are performed with either MSK ultrasound or x-ray.  This ensures accurate needle placement and best clinical outcomes. 

4) Avoid high dose steroids given their risks.

5) Consider regenerative therapies including platelets, prolotherapy and stem cells therapy.

6) Know that surgery may limit your future treatment options and advance the underlying condition.

7) Evaluate stability, articulation, neurologic and symmetry for maximum clinical outcome.

SANS-Infographic

December 31, 2012

Lumbar Disc Surgery Update: Disappointing

spine surgery

At the Centeno-Schultz Clinic we acknowledge that ow back and leg pain secondary to lumbar disc disease can be disabling. Stem cell therapy is an alternative to traditional back surgery.

Regenexx PL-Disc utilizes platelet growth factors to enhance blood flow and reduce inflammation at affected disc level and adjacent nerve roots. 

PL stands for ‘Platelet Lysate”.  We take our novel Super Concentrated Platelet (SCP) mix and break open all of the platelets to get the growth factors out.  Why?  Just like an immediate release pill, it is sometimes better to have more growth factors available to help stimulate cells towards repair.  So while SCP is like a time released pill which releases growth factors slowly, PL is like an immediate release pill.  Our experience dating back to 2005 has demonstrated that PL works best around nerves.

Poor blood supply is at the heart of why many patients with chronically pinched low back nerves fail to heal.  Regenexx PL-Disc is an out-patient “walk-in/walk-out” injection procedure where patients can immediately return to activity as tolerated.  Blood is drawn from your arm, processed in our lab and the separated platelets are concentrated and injected into the lumbar spine. Unlike conventional PRP injections (platelet rich plasma) PL quickly accelerates stem cell growth. This is because all of the growth factors in the platelets become immediately available to the local stem cells.

Success to date:

http://www.regenexx.com/2011/02/regenexx-pl-disc-works-in-this-patient-when-steroid-epidurals-fail/

http://www.regenexx.com/2012/12/epidural-steroid-injection-reviews-heres-a-patient-who-has-tried-both-steroids-and-using-his-own-growth-factors/

Lumbar surgery has been utilized for the treatment of low back pain and sciatica.

Results?

http://www.regenexx.com/2012/12/epidural-steroid-injection-reviews-heres-a-patient-who-has-tried-both-steroids-and-using-his-own-growth-factors/

Jacobs et al conducted a systematic literature review on the effect of surgical techniques for sciatica due to disc herniation to update the Cochrane review of 2007. Sixteen studies were included: seven from the original review and nine additional studies.

No conclusions can be drawn with regard to the comparative efficacy of open, microscopic, and tubular discectomy surgical techniques to treat sciatica due to a herniated disc.   There was no clinically relevant superiority of either technique.

2013:  Patients beware.  Explore treatment recommendations and ensure that none limit future options.

December 30, 2012

Epidural Steroid Injections: Risks

epidural-steroid-injections
At the Centeno-Schultz Clinic we acknowledge the pain, frustration and restriction in activity associated lumbar and cervical degenerative disc disease. Advanced treatment options include Regenexx PL where platelet growth factors are injected into the epidural space at the level of the degeneration or injury. The platelet growth factors increase the blood flow and increase inflammation.

High dose epidural steroids are utilized to treat lumbar and cervical disc disorders. Unfortunately the number of complications and risks associated with epidural steroids continues to increase.
Risks:
significant bone loss

suppression of hypothalamus-pituitary-adrenal (HPA) axis

elevation of blood glucose in diabetic patients

breakdown of  cartilage in animal studies

– ligament failure and breakdown.

In addition there is a signficant increase in the incidence of bone osteonecrosis in patients taking oral steroids.

In 2013 consider the risks associated with steroid injections and investigate the option of platelet derived growth factors.

September 16, 2012

Prolotherapy: Creating Stability

At the Centeno-Schultz Clinic stability is a central theme.  The importance of stability is discussed in Ortho 2.0.   The integrity of a joint is directly related to its stability.  Joint instability predisposes to additional injury and acceleration of the degenerative process.

Stability is the foundation or structural support of a joint.  A crumbling or weak foundation can not support a tall structure.   Instability can not support an active, healthy joint.

At the Centeno-Schultz Clinic prolotherapy is an effective treatment for joint instability.  Prolotherapy is regenerative injection procedure where a chemical irritant is used to cause a chemical micro-injury.  The irritant stimulates the body’s healing mechanism to repair and strengthen the degenerative and weakened tissues.  Prolotherapy initiates a three stage healing process:

Inflammatory:  occurs within the first week characterized by increased blood flow and swelling.

Fibroblastic:  1-6 weeks with fbroblasts creating new collagen and repairing injured tissue.

Maturation:  after 6 weeks characterized by stronger, more organized tissue.

Clinical examples where prolotherapy can be used to create stability include:

Supra and interspinous ligaments in lumbar spine.

Tendinosis & tendonitis of rotator cuff.

Lateral and medial epicondylitis.

Ankle sprains.

Antibiotic induced tendon damage.

ACL laxity or small tears.  Autologous stem cell therapy has been successfully used in full thickness tears in the ACL.

Stability is critical and prolotherapy is an effective therapy to stabilize a joint.

March 13, 2011

Nutrition and Stem Cell Therapy

Is there a correlation between nutrition and osteoarthritis?

Yes!

At the Centeno-Schultz Clinic and Regenexx we acknowledge the critical role between the two.

1 in 5 patients have metabolic syndrome characterized by central obesity, hypertension and elevated lipids and serum glucose. This syndrome results in the release of detrimental chemicals into the joints which can lead to the breakdown of cartilage matrix.

These same patients do poorly with knee and hip replacements due principally to the systemic proinflammatory state.

Obesity and hyperglycemia are associated with increased infection rates after knee replacements.

Diets rich in carbohydrates, refined sugar and processed food can promote a pre-diabetic state.   SIRT-1 gene expression plays an important role in circulating blood sugars levels and joint health.   Activation of SIRT-1 gene by dietary restriction and Resveratrol is associated with healthy cartilage.  Inactivation of SIRT-1 gene, commonly seen with aging and diets high in refined sugar and carbohydrates results in increased body fat, decreased energy and cartilage cells becoming less stable.  This can become the perfect storm for the onset of osteoarthritis.

In counseling deconditioned and overweight patients with osteoarthritic and musculoskeletal injuries, the Centeno-Schultz Clinic recommends at a minimum diet modification and increased activity levels.  These efforts are taken in an effort to optimize clinical outcomes from Regenexx SD, Regenexx AD and Regenexx SCP therapies.

March 3, 2011

Steroids and Cell Death: Apoptosis

 

Apoptosis is the process of programmed cell death.  The process is controlled by a variety of factors both within and outside of  cells.  High dose steroids have been demonstrated to create cell death in muscles, bones, cartilage and ligaments.  High dose steroids are commonly used to treat a variety of painful conditions which include rotator cuff tears, lateral epicondylitis, patellar and Achilles tendonitis, pes anersine bursitis,  lumbar facet dysfunction and sciatica.

At the Centeno-Schultz Clinic we acknowledge the negative effect of  high dose steroids.  Our aim is to identify the source of a patient’s pain and provide a therapy which will attempt to repair the damaged tissue.  Our treatments are not aimed at advancing the degenerative process or triggering apoptosis.  Accordingly we use only very small doses of steroids when necesary and have a large number of regenerative therapies which promote healing: prolotherapy, platelet rich plasma (PRP), Regenexx SCP, Regenexx AD and Regenexx SD.

February 3, 2011

Headaches Arising from Atlanto Occipital Joint

At the Centeno-Schultz Clinic we acknowledge that headaches can arise from many different sources including dysfunctional muscles, tears in the ligaments, misalignment of the vertebral bodies, injury to cervical facets and degenerative discs. 

The C0-C1 joint can cause significant headache and upper neck pain and should always be considered in the evaluation of the headaches not responsive to traditional therapy.  I have previouly discussed  the successful treatment of C0-C1 headache pain.

The C1-C0 joint, also referred to as the Atlanto-Occipital Joint(OA) is the first joint in the neck.  The base of the skull is the occiput.  The first bone in the neck is the atlas.  The joint bewtteen the two structures is susceptible to traumatic injury and degeneration.

The pain arising from the OA joint typically refers to the base of the skull as decpited.

Treatment options include prolotherapy, low doses of steroids and autologous mesenchymal stem therapy utilizing Regenexx SD.

Diagnosis is made by injecting a small amount of local anestheti into the joint under x-ray.  The neck is rich in nervies, veins and arteries which make injection into this area difficult and a potential source of complications.  Injection of dye (contrast) is essential to confirm accurate placement of the needle.  An image of contrast in the  C0-C1 joint is posted below.

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